Brain Pathology Case of the Month - July 2007

FINAL DIAGNOSIS: INFILTRATING MENINGIOMADISCUSSION:

Surgical excision and histopathological examination revealed that the lesion was in fact an infiltrating meningioma, which was histologically benign. The patient subsequently underwent a more extensive craniotomy with dural replacement grafting and cranioplasty. The patient is now physically well enough to return to work.

In the 1930s Harvey Cushing suggested that a significant etiologic factor in the development of meningiomas was trauma (1, 2). Other work at that time also suggested a possible link between trauma and glioma (3). There were very few reports between 1930 and 1995 to support Cushing's claims (4, 5). However, recently, there has been an increase in the number of cases which support this theory (6-10). A large case-control study with cases (n=330 meningiomas) from all over the world found that there was an increased risk of meningioma from head trauma [OR: 1.5, 95% CI: 0.9-2.6], particularly for males [OR: 5.4, 95% CI: 1.7-16.6] (11). Moreover, Phillips et al. (12) published a recent case-control study comparing 200 cases of meningioma with a history of head trauma and 400 healthy controls which also suggested an increased risk related to head trauma [OR: 1.83, 95% CI: 1.28-2.62]. The length of time between the trauma event and development of a meningioma also appear to be important with long latency periods (15-24 years) having the highest risk. Further studies are required to determine a causal link between head trauma and meningiomas. Physicians need to undertake a complete history and medical assessment on patients that present with lumps and bumps on the head.

ACKNOWLEDGEMENTS:

We would like to thank Peter Paton from the Department of Pathology, Nepean hospital, for his assistance with preparing the microphotographs for publication and Paul Sindler and Wayne Jones for assistance with information on the histopathology of this case.

REFERENCES:

Cushing H. The meningiomas: their source, and their favoured seats of origin. Brain 1922;5:282-316.